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Subclinical Carotid Atherosclerosis and Reduced DAD Score for Cardiovascular Risk Stratification in HIV-Positive Patients / Aterosclerose Carotídea Subclínica e DAD Escore Reduzido para Estratificação de Risco Cardiovascular em Pacientes HIV Positivos
Silva, Achilles Gustavo; Paulo, Rafael Vieira; Silva-Vergara, Mario León.
  • Silva, Achilles Gustavo; Universidade Federal do Triangulo Mineiro. Uberaba. BR
  • Paulo, Rafael Vieira; Universidade Federal do Triangulo Mineiro. Uberaba. BR
  • Silva-Vergara, Mario León; Universidade Federal do Triangulo Mineiro. Uberaba. BR
Arq. bras. cardiol ; 114(1): 68-75, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055082
Responsible library: BR1.1
ABSTRACT
Abstract

Background:

HIV-positive patients are twice as likely than the general population to have a heart attack and are four times at greater risk of sudden death. In addition to the increased risk, these individuals present with cardiovascular events on average approximately 10 years earlier than the general population.

Objective:

To compare Framingham and reduced DAD (Data Collection on Adverse Effects of Anti-HIV Drugs Cohort) scores for cardiovascular risk assessment in HIV-positive patients and potential impact on clinical decision after evaluation of subclinical carotid atherosclerosis.

Methods:

Seventy-one HIV-positive patients with no history of cardiovascular disease were clinically evaluated, stratified by the Framingham 2008 and reduced DAD scores and submitted to subclinical carotid atherosclerosis evaluation. Agreement between scores was assessed by Kappa index and p < 0.05 was considered statistically significant.

Results:

mean age was 47.2 and 53.5% among males. The rate of subclinical atherosclerosis was 39.4%. Agreement between scores was 49% with Kappa of 0.735 in high-risk patients. There was no significant difference between scores by ROC curve discrimination analysis. Among patients with intermediate risk and Framingham and reduced DAD scores, 62.5% and 30.8% had carotid atherosclerosis, respectively.

Conclusion:

The present study showed a correlation between the scores and medium-intimal thickening, besides a high correlation between patients classified as high risk by the Framingham 2008 and reduced DAD scores. The high prevalence of carotid atherosclerosis in intermediate risk patients suggests that most of them could be reclassified as high risk.
RESUMO
Resumo Fundamento Pacientes HIV positivos possuem 2 vezes maior risco que a população geral de apresentarem infarto e 4 vezes maior de morte súbita. Além do risco aumentado, esses indivíduos apresentam eventos cardiovasculares, em média, aproximadamente, 10 anos antes que a população geral.

Objetivo:

Comparar os escores Framingham e DAD reduzido para avaliação de risco cardiovascular em pacientes HIV positivos e o potencial impacto na decisão clínica após avaliação de aterosclerose carotídea subclínica.

Métodos:

Foram avaliados clinicamente 71 pacientes HIV positivos sem antecedentes de doenças cardiovasculares, estratificados pelos escores Framingham 2008 e DAD reduzido e submetidos a avaliação de aterosclerose carotídea subclínica. A concordância entre os escores foi avaliada pelo índice Kappa e os valores de p < 0,05 foram considerados estatisticamente significativos.

Resultados:

A idade média foi 47,2 e 53,5% do sexo masculino. A ocorrência de aterosclerose subclínica foi de 39,4%. A concordância entre os escores foi de 49% com Kappa de 0,735 nos pacientes de alto risco. Não houve diferença significativa entre os escores por meio de análise de discriminação com curva ROC. Dos pacientes com risco intermediário no Framingham e DAD reduzido, 62,5% e 30,8% respectivamente apresentavam aterosclerose carotídea.

Conclusão:

O presente estudo mostrou correlação entre os escores e espessamento médio-intimal e alta concordância entre os pacientes classificados como alto risco nos escores Framingham 2008 e DAD escore reduzido. A observação de alta prevalência de aterosclerose carotídea em pacientes de risco intermediário sugere que grande parte desses pacientes poderia ser reclassificada como alto risco.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Carotid Artery Diseases / HIV Infections Type of study: Etiology study / Prognostic study / Risk factors Limits: Adult / Female / Humans / Male Language: English Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal do Triangulo Mineiro/BR

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Full text: Available Index: LILACS (Americas) Main subject: Carotid Artery Diseases / HIV Infections Type of study: Etiology study / Prognostic study / Risk factors Limits: Adult / Female / Humans / Male Language: English Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade Federal do Triangulo Mineiro/BR